Does icing an injury delay recovery?

Do you practice health rituals that work for you even though there is very little evidence of their efficacy? For years I was told that eating carrots would improve my night vision, chocolates cause pimples and cold weather triggers a cold. Several friends are adamant that the flu shot causes flu. Although these beliefs are unproven, those who follow them are convinced they make sense. 

If I sprain an ankle, the first thing I do is grab a packet of frozen peas to ice the injury. This, was the so called golden rule to speed up recovery. Experts claimed that ice reduces pain and swelling, and stops inflammation. According to them, preventing inflammation was key to fast healing. Icing was an essential part of this theory. In 1978 Dr Mirkin created the acronym RICE. It promotes rest, ice, compression and elevation. These principles were regarded as the optimum treatment for a soft tissue injury. 

 

Recently icing has become a hot topic of discussion. The latest research shows inflammation is  an essential part of recovery. It’s the body’s natural response to an injury. Icing it is counterproductive and delays the process.  Evidence suggests that inflammation should be allowed to run its course.  Dr Mirkin doesn’t promote icing any longer.

https://thesportjournal.org/article/the-r-i-c-e-protocol-is-a-myth-a-review-and-recommendations/

 

Dr Marcel Jooste, sports physician at the Sport, Exercise, Medicine and lifestyle Institute at  University of Pretoria (SEMLI) supports this philosophy. He says the benefits of icing are questionable.  Despite the widespread use of it, there isn’t sufficient proof to support it.   Although he admits icing could relieve pain and swelling immediately after the injury, Jooste and many professional sport doctors practice the Peace and Love method. This acronym was created in 2020 and involves a holistic approach to the management of an injury from immediate to long term care.

 

It focuses on the person with the injury rather than the injury of the person. Jooste believes that it’s important for patients to become actively involved in their rehabilitation. A positive attitude he says is vital and ensures faster and full recovery.  

Is icing altogether out? 

Dr Mike Marshall, team doctor of the Sharks says he believes RICE is a very useful method to treat soft tissue injuries. Theoretically speaking, the new approach makes sense, but in practice icing a sprain has many benefits. It helps reduce the pain without the side effects of various medications. It prevents swelling and also limits the torn tissue from bleeding and causing secondary damage. Excessive bleeding increases scar tissue from developing and swelling slows down recovery.  Marshall recommends icing approximately every four hours for 20 minutes during the first 24 -48 hours. He says it does not stop blood flow altogether, if done intermittently, but restricts the use of ice to the acute phase. Marshall believes there is insufficient evidence to prove that the use of ice initially, will delay the onset of healing. There is however evidence that anti-inflammatory medication can slow down recovery. Once the injury is stabilized one should allow the natural inflammation process to run its course. David Milner, who’s been Kaizer Chief’s physiotherapist for 23 years says “ the body is exceptionally complex and timing around inflammation important”.  Milner sticks to the RICE method until more evidence convinces him differently. He says the new theory has not stood the test of time and he prefers to work with concepts that have proven results. He warns against anti-inflammatories as he believes they inhibit the body’s natural ability to fight inflammation. He recommends taking a paracetamol if necessary. “One should start to move again as soon as possible. If one’s pain score is about 2-3 out of 10, one should systematically increase weight bearing exercises. This will help strengthen and stretch the muscles and prevent muscle dystrophy.  

What do athletes say?

Despite the misgivings about the efficacy of icing,  many top athletes and coaches still prefer the RICE approach. Nick Bester, a Comrades and Ironman winner  and national manager of the Nedbank running clubs says icing is crucial. He recommends that one straps and compresses a sprain to keep it in the correct position and minimise the swelling. One should continue to exercise to encourage the blood flow and oxygen to the affected area. If the injury is too painful to move, one could focus on alternative exercises such as swimming, gym or cycling that do not involve the injury, until one is able to resume exercising the damaged ligament or muscle gradually.  Additional treatments such as physio, laser and frequency also encourage blood flow and promote the production of a growth hormone that will speed up recovery. 

Gerda Steyn winner of the Comrades and Two Oceans marathon says she uses ice but will get professional medical advice to establish the best treatment that will avoid delayed recovery time. She says the body will heal itself but sufficient rest is essential to allow the process to take place. Hendrik Ramaala, running coach and winner of the New York and Mumbai marathons also believes in icing a sprain and getting professional advice as soon as possible. 

While the jury is out, do whatever works for you.  Milner, physiotherapist, concludes that a British soccer manager told him that despite the new information available, a sprain injury takes about three weeks to heal whether you treat it actively or leave the body to heal itself.